Last month a package for renewing general practice in England was finally announced in the GP Forward View. It opened with the heady statement by NHS England chief executive Simon Stevens: ‘There is arguably no more important job in modern Britain than that of the family doctor’."
This conveys the value of the services we provide, which together add up to quite a buzz of meaningful activity across the country’s consulting rooms and patient homes. Given the maxim that actions speak louder than words, though, let’s see how the support being offered might affect our own health and wellbeing.
As described in my last article we can think about work strain and burnout as resulting from a mismatch between demands and resources. The GP Forward View represents an important and significant commitment to shift the current imbalance between demands and resources towards a more sustainable working life for GPs.
At last we get a proper rise in funding, a concerted effort is being made to recruit and retain more GPs, as well as to provide more access to pharmacists, mental health workers, and skilled-up administrative teams.
Resources are being made available to implement more streamlined IT and for the interface with secondary care to be less punishing. The onerous burdens of CQC are being addressed, as well as eye-wateringly high indemnity costs. These are all good ways of tackling the stress of the work, and hopefully will have a significant impact on our health.
For those struggling with stress and burnout there is going to be national support, the detail of which is awaited. Similarly, practices that are vulnerable will be able to access a practice resilience programme, though again the detail is yet to be defined.
Prepare for change
But there is more, much more, and so we need to tighten our seat belts and be prepared for change.
What is being proposed is a 'triple reinvention' – of the clinical model, of the business model and of the career model.
General practice has been so caught up in a treadmill of reactivity and reorganisation that there has been scant time to develop systems that free up time. As NHS England director of primary care Dr Arvind Madan writes in his preface to the Forward View ‘teams need support and space if they are to adopt new ways of working.’
This statement delights me.
Change is stressful, and I’m concerned about how we will cope with yet more of it in this ‘triple reinvention’. From research I have conducted with senior GPs, they felt progressively alienated as NHS changes reconfigured their role, identity and working life, without themselves having much say in these changes.
For change to really be embraced by those living it, they need to be involved in tailoring the changes. If change is done to us, foisted down through a command and control hierarchy, we become sidelined and disengaged.
If, however, we have the time to collaborate on change initiatives within our teams, we can be engaged and curious, and ultimately proud of what we achieve.
I am pleased that practice development support will be on offer, and look forward to seeing what this means in practice – how much and what type of support. Investing in building strong teams and working relationships will be a great foundation for any future development.
How can we make this work for us?
The key question is: ‘How can we take NHS England’s agenda for working at scale, extended access and multidisciplinary team working, and shape it in a way that excites and energises us?’
Working across organisational and professional boundaries is increasingly necessary in the complex world of contemporary public services. Yet facing the ambiguity and uncertainty this entails is stressful. If not properly resourced, we might naturally shy away from it and revert to comfy tribalism. So I hope to see plenty of leadership skills training, and ongoing development.
Dr Madan seems to suggest that the envisaged new clinical model for GPs will be more firmly based on dealing with the most complex cases, with continuity of care only where signposting to another member of the team is not appropriate, and a stronger role in liaising with the wider community team.
With more or less no mention made in the GP Forward View of consultation time, this concerns me. We all know that our follow-ups and pill checks can be what helps alleviate the intense adrenaline-soaked pressure of 10-minute consultations. To my mind creating appointment times to match the complexity of work we do would be one of the smartest innovations we could implement.
There are plenty of opportunities for general practice within the GP Forward View. To help us have happier, more satisfying working lives, we will need to attend to the details, and be careful to shape changes so that they really do allow us to work in smarter, more connected ways. The organisational development input we receive must not just be about technical fixes, but also about increasing our skills in leadership, team development, communication and collaboration.
- Dr Jennifer Napier is a GP with special interest in occupational medicine. She has researched wellbeing and workforce issues, and works through Contextualyse to train and consult on how to create healthy, productive workplaces.